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      A Public Health Approach to Address the Mental Health Burden of Youth in Situations of Political Violence and Humanitarian Emergencies

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          Abstract

          This paper describes how socio-ecological theory and a syndemic health systems and public health approach may help address the plight of youth in situations of political violence and humanitarian emergencies. We describe the treatment gap caused by discrepancies in epidemiological prevalence rates, individual and family needs, and available human and material resources. We propose four strategies to develop a participatory public health approach for these youth, based on principles of equity, feasibility, and a balance between prevention and treatment. The first strategy uses ecological and transgenerational resilience as a theoretical framework to facilitate a systems approach to the plight of youth and families. This theoretical base helps to engage health care professionals in a multisectoral analysis and a collaborative public health strategy. The second strategy is to translate pre-program assessment into mental health and psychosocial support (MHPSS) priorities. Defining priorities helps to develop programs and policies that align with preventive and curative interventions in multiple tiers of the public health system. The third is a realistic budgetary framework as a condition for the development of sustainable institutional capacity including a monitoring system. The fourth strategy is to direct research to address the knowledge gap about effective practices for youth mental health in humanitarian settings.

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          Most cited references41

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          Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum.

          Childhood maltreatment or abuse is a major risk factor for mood, anxiety, substance abuse, psychotic, and personality disorders, and it is associated with reduced adult hippocampal volume, particularly on the left side. Translational studies show that the key consequences of stress exposure on the hippocampus are suppression of neurogenesis in the dentate gyrus (DG) and dendritic remodeling in the cornu ammonis (CA), particularly the CA3 subfield. The hypothesis that maltreatment is associated with volume reductions in 3-T MRI subfields containing the DG and CA3 was assessed and made practical by newly released automatic segmentation routines for FreeSurfer. The sample consisted of 193 unmedicated right-handed subjects (38% male, 21.9 ± 2.1 y of age) selected from the community. Maltreatment was quantified using the Adverse Childhood Experience study and Childhood Trauma Questionnaire scores. The strongest associations between maltreatment and volume were observed in the left CA2-CA3 and CA4-DG subfields, and were not mediated by histories of major depression or posttraumatic stress disorder. Comparing subjects with high vs. low scores on the Childhood Trauma Questionnaire and Adverse Childhood Experience study showed an average volume reduction of 6.3% and 6.1% in the left CA2-CA3 and CA4-DG, respectively. Volume reductions in the CA1 and fimbria were 44% and 60% smaller than in the CA2-CA3. Interestingly, maltreatment was associated with 4.2% and 4.3% reductions in the left presubiculum and subiculum, respectively. These findings support the hypothesis that exposure to early stress in humans, as in other animals, affects hippocampal subfield development.
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            A developmental psychopathology perspective on child abuse and neglect.

            The purpose of this review is to conceptualize child abuse and neglect within a developmental psychopathology perspective. Toward this end, issues of definition and epidemiology, etiology, and sequelae are addressed. Research and theory on child abuse and neglect with relevance to a developmental perspective is reviewed. Considerable progress has been made in our understanding of the etiology and consequences of child abuse and neglect. Less progress has been made in utilizing this knowledge to inform treatment efforts. Incorporation of a developmental psychopathology perspective into efforts to understand and ameliorate the adverse effects of child abuse and neglect holds considerable promise for advancing research and intervention in the area of child maltreatment. The importance of providing comprehensive and coordinated services that incorporate knowledge of how maltreated youngsters negotiate stage-salient issues of development is stressed. The provision of child-focused treatment, parent-based models of intervention, and ecologically driven approaches to prevention all can benefit from an understanding of the adverse effects that maltreatment exerts on the process of development.
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              Posttraumatic stress disorder: the burden to the individual and to society.

              Little is known about the total population prevalence and societal costs of posttraumatic stress disorder (PTSD); this report reviews relevant literature on these topics. A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD. PTSD was found to be a commonly occurring disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence. PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. Early and aggressive outreach to treat people with PTSD could help reduce the enormous societal costs of this disorder.
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                Author and article information

                Contributors
                jtvmdejong@gmail.com
                L.h.berckmoes@uva.nl
                brandon.kohrt@duke.edu
                suzan.song@post.harvard.edu
                wtol@jhu.edu
                r.reis@uva.nl
                Journal
                Curr Psychiatry Rep
                Curr Psychiatry Rep
                Current Psychiatry Reports
                Springer US (New York )
                1523-3812
                1535-1645
                30 May 2015
                30 May 2015
                2015
                : 17
                : 7
                : 60
                Affiliations
                [ ]Amsterdam Institute of Social Science Research (AISSR) University of Amsterdam, Nieuwe Achtergracht 166, 1018WV Amsterdam, The Netherlands
                [ ]Boston University School of Medicine, Boston, MA USA
                [ ]Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
                [ ]Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
                [ ]Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands
                [ ]The Children’s Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
                Article
                590
                10.1007/s11920-015-0590-0
                4452256
                26021862
                eb26f596-fb87-4478-939b-e7af6cea9948
                © The Author(s) 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Child and Family Disaster Psychiatry (B Pfefferbaum, Section Editor)
                Custom metadata
                © Springer Science+Business Media New York 2015

                Clinical Psychology & Psychiatry
                public health,youth,humanitarian emergencies,resilience,mental health,syndemics

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